Trial of Patterned Oral Somatosensory Entrainment for Shortening Time to Oral Feeding

Patterned Oral Somatosensory Intervention The interventions (Treatment vs Control) will be initiated simultaneously with tube (gavage) feeds as early as 30 weeks post-menstrual age. Before and during each training session the infant will be evaluated for the following criteria: Criteria for Initiation of each intervention: 1. Not on continuous vasopressor medications 2. Feeding in previous 48 hours. 3. Not mechanically ventilated. If the infant is on CPAP or Nasal cannula \>2 liters per minute, then the FiO2 must be \<40%. Criteria for Exiting an Intervention Session: 1. If during an intervention the baby experiences Apnea/Bradycardic/Desaturation events requiring nursing stimulation or intervention during the training--hold future interventions for one session. 2. If the interventions are held for 3 consecutive sessions, hold interventions for a full day (24 hours). 3. If interventions are held for 3 days (72 hours) and if GA is \<32 weeks when ready to restart therapy sessions, then complete another 10 days of interventions. 4. If interventions are held for 3 days (72 hours) and if GA is \>32 weeks when ready to restart therapy, then complete the remaining N interventions sessions for a total of 10 days of therapy. 5. If interventions are held for 3 days (72 hours) and the infant is on full oral feeds when ready to restart therapy interventions then discontinue any remaining interventions sessions. The Interventions Infants in the Treatment and Control group will receive orocutaneous stimulation up to four times daily during the first 30 minutes of a tube (gavage) feeding session to achieve an average of 30 therapy sessions distributed over a two week period. Infants assigned to the either group will be offered the pacifier by gently placing the pacifier on the lips. The pacifier should not be forced into the mouth and should not be moved in any manner that would represent any form of patterned input such as moving the pacifier in and out, tapping on the lips or face or massaging the mouth or oral facial structure. All other preparatory, infant positioning, and sampling conditions will be equal among groups. The healthcare team will continue to promote feeding and growth at the standard of care for babies in both groups. Treatment Group Infants in the Treatment group will receive the NTrainer System® patterned synthetic orocutaneous stimulation. A single NTrainer intervention runs for 20 minutes and involves three 3 minute sessions during which the pacifier pulses. The pulsing sessions are separated by 5.5 min breaks where the pacifier is quiet. Control Group Infants assigned to the control group will receive an orocutaneous intervention in which the infant will be offered a 20 minute non-nutritive sucking opportunity with a 'quiet' pacifier. Breast Feeding Non-nutritive breastfeeding and nutritive breastfeeding practice will not be altered or changed by the interventions. The availability of the mother will be taken into consideration for the scheduling of any intervention sessions and no study intervention will interfere with breastfeeding behavior. Safety To help ensure the safety of the study participants the heart rate, oxygen saturation, and blood pressure will be monitored throughout the therapy session.